Optimizing spinal stimulation intensity for gait training in cerebral palsy

Children with cerebral palsy experience motor impairments, including spasticity and altered gait, which negatively impact mobility and quality of life. Transcutaneous spinal cord stimulation has emerged as a promising non-invasive intervention to improve motor function for children with cerebral palsy. Preliminary studies suggest that spinal stimulation, when combined with activity-based neurorehabilitation or treadmill training, may significantly reduce spasticity and enhance gait performance. However, a key challenge in translating this novel technology into clinical practice is a lack of standardized methods to determine and optimize stimulation intensity. Currently, stimulation intensity is largely set through trial-and-error, which limits consistency across clinical trials and hinders mechanistic understanding. This research aims to systematically evaluate the effects of spinal stimulation intensity on gait biomechanics for individuals with cerebral palsy. In Aim-1, we will quantify changes in gait kinematics, kinetics, and muscle activity in response to varying stimulation intensities applied at the lower spine. Twenty ambulatory children with bilateral cerebral palsy will complete structured treadmill and overground walking trials across two visits, allowing us to assess sensitivity and repeatability of gait responses to spinal stimulation. In Aim-2, we will compare optimal stimulation intensities from biomechanical, clinical, and patient perspectives. Participants will provide their preferences during walking trials, while clinicians will assess gait improvements through video ratings. Focus groups with individuals with cerebral palsy and clinicians will refine these comparisons, leading to evidence-based guidelines for future research with spinal stimulation. This research will provide critical insights into how spinal stimulation intensity modulates gait and establish foundational methods for standardizing stimulation intensity. By integrating biomechanical analysis with patient and clinician perspectives, we aim to advance neuromodulation strategies for cerebral palsy, paving the way for future clinical trials and personalized, data- driven approaches to spinal stimulation therapy. Project Number: 1R21HD121135-01 | Fiscal Year: 2026 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Katherine Steele (+1 co-PI) | Institution: UNIVERSITY OF WASHINGTON, SEATTLE, WA | Award Amount: $383,200 | Activity Code: R21 | Study Section: Special Emphasis Panel[ZRG1 MSOS-E (05)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11310983